St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CLASS III PHARMACOTHERAPY

Facility

$322.67

Service Code	EAPG 00437
Min. Negotiated Rate	$233.74
Max. Negotiated Rate	$322.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$233.74
Rate for Payer: Healthfirst Commercial	$322.67

CLASS III THERAPEUTIC RADIOPHARMACEUTICALS

Facility

$1,464.95

Service Code	EAPG 00245
Min. Negotiated Rate	$1,464.95
Max. Negotiated Rate	$1,464.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,464.95

CLASS II PHARMACOTHERAPY

Facility

$179.69

Service Code	EAPG 00436
Min. Negotiated Rate	$129.60
Max. Negotiated Rate	$179.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$129.60
Rate for Payer: Healthfirst Commercial	$179.69

CLASS II THERAPEUTIC RADIOPHARMACEUTICALS

Facility

$504.52

Service Code	EAPG 00244
Min. Negotiated Rate	$504.52
Max. Negotiated Rate	$504.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$504.52

CLASS I PHARMACOTHERAPY

Facility

$59.90

Service Code	EAPG 00435
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$59.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43.97
Rate for Payer: Healthfirst Commercial	$59.90

CLASS I THERAPEUTIC RADIOPHARMACEUTICALS

Facility

$20.83

Service Code	EAPG 00243
Min. Negotiated Rate	$20.83
Max. Negotiated Rate	$20.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.83

CLASS IV PHARMACOTHERAPY

Facility

$541.01

Service Code	EAPG 00438
Min. Negotiated Rate	$393.43
Max. Negotiated Rate	$541.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$393.43
Rate for Payer: Healthfirst Commercial	$541.01

CLASS IX COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$4,053.74

Service Code	EAPG 00461
Min. Negotiated Rate	$2,943.79
Max. Negotiated Rate	$4,053.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,943.79
Rate for Payer: Healthfirst Commercial	$4,053.74

CLASS VIII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$2,938.86

Service Code	EAPG 00460
Min. Negotiated Rate	$2,133.78
Max. Negotiated Rate	$2,938.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,133.78
Rate for Payer: Healthfirst Commercial	$2,938.86

CLASS VII PHARMACOTHERAPY

Facility

$2,042.32

Service Code	EAPG 00444
Min. Negotiated Rate	$1,483.47
Max. Negotiated Rate	$2,042.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,483.47
Rate for Payer: Healthfirst Commercial	$2,042.32

CLASS VI PHARMACOTHERAPY

Facility

$1,364.13

Service Code	EAPG 00440
Min. Negotiated Rate	$990.52
Max. Negotiated Rate	$1,364.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$990.52
Rate for Payer: Healthfirst Commercial	$1,364.13

CLASS V PHARMACOTHERAPY

Facility

$875.28

Service Code	EAPG 00439
Min. Negotiated Rate	$636.43
Max. Negotiated Rate	$875.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$636.43
Rate for Payer: Healthfirst Commercial	$875.28

CLASS X COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$6,440.00

Service Code	EAPG 00462
Min. Negotiated Rate	$4,674.89
Max. Negotiated Rate	$6,440.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4,674.89
Rate for Payer: Healthfirst Commercial	$6,440.00

CLASS XI COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$10,387.47

Service Code	EAPG 00463
Min. Negotiated Rate	$7,539.99
Max. Negotiated Rate	$10,387.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7,539.99
Rate for Payer: Healthfirst Commercial	$10,387.47

CLASS XII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$15,942.52

Service Code	EAPG 00464
Min. Negotiated Rate	$11,573.81
Max. Negotiated Rate	$15,942.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11,573.81
Rate for Payer: Healthfirst Commercial	$15,942.52

CLEAR EYES CONTACT LENS RELIEF SOLN

Facility

$0.34

Service Code	NDC 7811265321
Hospital Charge Code	7811265321
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

CLEAR EYES CONTACT LENS RELIEF SOLN

Facility

$0.34

Service Code	NDC 7811265321
Hospital Charge Code	7811265321
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.23
Rate for Payer: EmblemHealth Commercial	$0.17
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.22

CLEFT LIP AND PALATE REPAIR

Facility

$3,876.45

Service Code	EAPG 00262
Min. Negotiated Rate	$3,876.45
Max. Negotiated Rate	$3,876.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,876.45

Cleft lip & palate repair

Facility

$76,750.38

Service Code	APR-DRG 0954
Min. Negotiated Rate	$14,438.00
Max. Negotiated Rate	$76,750.38
Rate for Payer: Affinity Essential Plan 1&2	$76,750.38
Rate for Payer: Affinity Essential Plan 3&4	$76,750.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,111.28
Rate for Payer: Amida Care Medicaid	$34,111.28
Rate for Payer: EmblemHealth Essential Plan 1&2	$76,750.38
Rate for Payer: EmblemHealth Essential Plan 3&4	$34,111.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,111.28
Rate for Payer: Fidelis Qualified Health Plan	$40,933.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,111.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,111.28
Rate for Payer: Healthfirst Commercial	$26,447.00
Rate for Payer: Healthfirst Essential Plan	$76,750.38
Rate for Payer: Healthfirst QHP	$14,438.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,111.28
Rate for Payer: SOMOS Essential	$76,750.38
Rate for Payer: United Healthcare Essential Plan 1&2	$76,750.38
Rate for Payer: United Healthcare Essential Plan 3&4	$76,750.38
Rate for Payer: United Healthcare Medicaid	$34,111.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,111.28

Cleft lip & palate repair

Facility

$44,625.13

Service Code	APR-DRG 0951
Min. Negotiated Rate	$7,478.00
Max. Negotiated Rate	$44,625.13
Rate for Payer: Affinity Essential Plan 1&2	$44,625.13
Rate for Payer: Affinity Essential Plan 3&4	$44,625.13
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,833.39
Rate for Payer: Amida Care Medicaid	$19,833.39
Rate for Payer: EmblemHealth Essential Plan 1&2	$44,625.13
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,833.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,833.39
Rate for Payer: Fidelis Qualified Health Plan	$23,800.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,833.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,833.39
Rate for Payer: Healthfirst Commercial	$13,087.00
Rate for Payer: Healthfirst Essential Plan	$44,625.13
Rate for Payer: Healthfirst QHP	$7,478.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,833.39
Rate for Payer: SOMOS Essential	$44,625.13
Rate for Payer: United Healthcare Essential Plan 1&2	$44,625.13
Rate for Payer: United Healthcare Essential Plan 3&4	$44,625.13
Rate for Payer: United Healthcare Medicaid	$19,833.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,833.39

Cleft lip & palate repair

Facility

$56,399.92

Service Code	APR-DRG 0953
Min. Negotiated Rate	$13,121.00
Max. Negotiated Rate	$56,399.92
Rate for Payer: Affinity Essential Plan 1&2	$56,399.92
Rate for Payer: Affinity Essential Plan 3&4	$56,399.92
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,066.63
Rate for Payer: Amida Care Medicaid	$25,066.63
Rate for Payer: EmblemHealth Essential Plan 1&2	$56,399.92
Rate for Payer: EmblemHealth Essential Plan 3&4	$25,066.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,066.63
Rate for Payer: Fidelis Qualified Health Plan	$30,079.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,066.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,066.63
Rate for Payer: Healthfirst Commercial	$22,406.00
Rate for Payer: Healthfirst Essential Plan	$56,399.92
Rate for Payer: Healthfirst QHP	$13,121.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,066.63
Rate for Payer: SOMOS Essential	$56,399.92
Rate for Payer: United Healthcare Essential Plan 1&2	$56,399.92
Rate for Payer: United Healthcare Essential Plan 3&4	$56,399.92
Rate for Payer: United Healthcare Medicaid	$25,066.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,066.63

Cleft lip & palate repair

Facility

$47,968.49

Service Code	APR-DRG 0952
Min. Negotiated Rate	$9,006.00
Max. Negotiated Rate	$47,968.49
Rate for Payer: Affinity Essential Plan 1&2	$47,968.49
Rate for Payer: Affinity Essential Plan 3&4	$47,968.49
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,319.33
Rate for Payer: Amida Care Medicaid	$21,319.33
Rate for Payer: EmblemHealth Essential Plan 1&2	$47,968.49
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,319.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,319.33
Rate for Payer: Fidelis Qualified Health Plan	$25,583.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,319.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,319.33
Rate for Payer: Healthfirst Commercial	$15,429.00
Rate for Payer: Healthfirst Essential Plan	$47,968.49
Rate for Payer: Healthfirst QHP	$9,006.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,319.33
Rate for Payer: SOMOS Essential	$47,968.49
Rate for Payer: United Healthcare Essential Plan 1&2	$47,968.49
Rate for Payer: United Healthcare Essential Plan 3&4	$47,968.49
Rate for Payer: United Healthcare Medicaid	$21,319.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,319.33

CLINDAMYCIN HCL 150 MG PO CAPS

Facility

$0.73

Service Code	NDC 0904595961
Hospital Charge Code	0904595961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.37

CLINDAMYCIN HCL 150 MG PO CAPS

Facility

$1.19

Service Code	NDC 6330469201
Hospital Charge Code	6330469201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.60
Rate for Payer: Aetna Government	$0.60
Rate for Payer: Brighton Health Commercial	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.81
Rate for Payer: EmblemHealth Commercial	$0.60
Rate for Payer: Group Health Inc Commercial	$0.60
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.60
Rate for Payer: Hamaspik Choice Inc Medicare	$0.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.77

CLINDAMYCIN HCL 150 MG PO CAPS

Facility

$0.73

Service Code	NDC 0904595961
Hospital Charge Code	0904595961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.37
Rate for Payer: Aetna Government	$0.37
Rate for Payer: Brighton Health Commercial	$0.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.50
Rate for Payer: EmblemHealth Commercial	$0.37
Rate for Payer: Group Health Inc Commercial	$0.37
Rate for Payer: Group Health Inc Medicare	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.37
Rate for Payer: Hamaspik Choice Inc Medicare	$0.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.48

Know your out-of-pocket cost for care.

All Charges